Please note: We do not agree with the line taken by the reporter in this article. She did not present the whole story. She only presented the line being put forward by the government (and the Ontario Hospital Association). In fact, we provided a great deal of information and patient contact for this article but were not credited for it. The OHA has not helped to fight the hospital cuts for the last nine years while citizens’ groups, local health coalitions and the Ontario Health Coalition organized tirelessly town by town to save services.

It appears that there is a deal between the large hospital CEOs and the government — the government has not taken on exorbitant hospital CEO salaries in any real way and the CEOs have not challenged the cuts in any real way, with a few exceptions in a few cities.

For this article, we pointed out that the so-called “Alternate Level of Care” patient stats are being misused to cover up the damage caused by hospital bed cuts. (A significant portion of ALC patients are not ready to be discharged at all, they are, in fact, waiting in one type of hospital bed for another type of hospital bed). Further ALC patients are no justification for putting emergency department patients in closets and hallways for days. These facts were ignored by the reporter. We also pointed out that Ontario has the fewest hospital beds per person in Canada and is right at the bottom of the entire OECD (developed countries). This fact is misportrayed as being evidence of “efficiency”. It is not efficient to have the highest hospital readmission rates in the country because there are too few hospital beds.

Health Care Advocates Dismayed with Ottawa’s Divide and Conquer Tactics:Hopes for a Canadian Health Accord Dashed as Provinces Signs Deal

Toronto/Ottawa/Edmonton: The Ontario, Quebec and Alberta governments, which had initially held out for better, were compelled to sign onto a bilateral health funding deal with Ottawa today. In the federal election, the Trudeau government promised to break with the high-handed approach of the previous Harper government and negotiate a new Health Accord with the provinces and territories. Instead, after tabling a take-it-or-leave-it offer in December, Trudeau’s government walked away from the table. It is now forcing through bilateral deals with each province, containing a funding level that is inadequate to meet the health care needs of Canadians and was rejected by the provinces and territories as inadequate in December. The scheme will reduce the federal government’s share of health care funding over the next decade, reversing gains made in the 2004 Health Accord.

With the reported signing of bilateral deals by Quebec, Ontario and Alberta today, hope for a Health Accord that will protect and improve Canadians’ equal access to health care for the next decade is gone. Health care will now become a major issue leading into the next federal election, advocates vow.

The bilateral deals set the federal funding level at nominal GDP with a floor of three percent and additional “targeted” funding for mental health and home care. Text of the bilateral deals has not been revealed to the public. In the December Federal-Territorial-Provincial Finance Ministers’ meeting, the provinces and territories were calling for a Canada Health Transfer funding escalator that would match projected health care cost growth at 5.2 percent. The expected need for health care funding growth is projected to be 5.2 percent, not 3 percent. There is a broad consensus about this projection. It is in line with the estimates of the Parliamentary Budget Office, the Financial Accountability Office of Ontario and the Conference Board of Canada. Health care advocates are concerned about the process of bilateral deals rather than an equitable national approach leading to inequities across Canada, inadequate funding, and secret language.

“We are disheartened by the Trudeau government’s divide and conquer tactics,” said Adrienne Silnicki, national coordinator of the Canadian Health Coalition. “The Health Accord negotiations were supposed to be an opportunity to strengthen public health care. Instead we are seeing a funding deal that will force cuts to services and does not commit to upholding the principle of equity in public health care. The federal government is not just abdicating its responsibility to uphold single-tier public health care, it is threatening its future.”

“The bottom line is that the funding deal being forced through by Trudeau’s government does not meet the evidence for what is needed in Ontario and across Canada. The shortfall will have to be made up by the provinces which have less fiscal room to do so, or services will be cut and privatized,” said Natalie Mehra, executive director of the Ontario Health Coalition. “We are deeply concerned that inequities in access to needed health care for Canadian patients will widen as a result of the Trudeau government’s tactics. They have put PR before good policy and we fear that Canadian patients will pay the price.”

“Instead of using the opportunity afforded by a Health Accord to strengthen national standards for Canadian patients, the Trudeau government has done the opposite. We are deeply dissapointed,” said Sandra Azocar, executive director of Alberta’s Friends of Medicare. “Canadians need equal access to quality public health care no matter where they live in the country.”

Ontario Association of Non-Profit Homes and Services for Seniors

As one of our key partners in advocating for quality care and services for Ontario’s seniors, we wanted to share with you the priorities OANHSS put forward for the upcoming Provincial Budget and for consideration for in-year allocations.

·Long Term Care (LTC) capacity: 2,5000-5,000 new beds over the next two years with a minimum of 50% dedicated to NFP providers.

·Resident health and safety: Funding for staffing increases to achieve a provincial average of 4.0 paid hours of direct care per resident per day over the next two years. A minimum increase of 3.9% ($0.33) to the daily food budget to bring it to $8.66 per resident.

·Resident acuity and responsive behaviours: Dedicated behaviour teams in every LTC home and a minimum of 12 more designated behaviour units.

·Seniors’ campuses: Large-scale study of existing seniors’ campuses to determine how the province and LHINs can enable their development. Ministry of Housing specifically identify seniors as a priority population for new affordable housing with seniors’ campuses as a stated priority.

We strongly believe that investments focused on these areas are critical to strengthening the long term care system so that it better serves Ontario’s seniors.

We appreciate you taking the time to review our submission. Please feel free to contact me if you have any questions. The full report can be found online here.

Patients First Act, 2016 Introduced

On Thursday, [June 2, 2016] the Provincial Government introduced Bill 210, called the Patients First Act, 2016, which proposes the most substantial health care system restructuring that Ontario has experienced in 20 years to better “…promote health equity, reduce health disparities and inequities, and respect the diversity of communities in the planning, design, delivery and evaluation of services”.

If passed, the proposed changes will significantly impact both patients and providers. It amends several pieces of health legislation and includes the elimination of the CCACs and the transfer of their functions to the 14 LHINs (Local Health Integration Networks). The government maintains that it will enhance access to care, reduce red-tape, and save tax dollars.

You may review the bill (which is draft legislation) for yourselves through the Legislature’s site http://bit.ly/1PDUzDS.

The government reintroduced the proposed Seniors Active Living Centres Act Dec. 8, 2016 as part of the omnibus bill, the proposed Protecting Patients Act. As most of you may know, the Seniors Active Living Centres Act was originally introduced June 1, 2016. However, as the result of the prorogation of the legislature on September 8, 2016, all legislation had to be reintroduced.

An omnibus bill is proposed legislation that packages together several distinct pieces of legislation. The proposed Protecting Patients Act includes four Ministry of Health and Long-Term Care items (schedules 1-4) in addition to the modernized EPC legislation (Schedule 5).

We have provided you with a link to the government’s news release regarding the introduction of the legislation here, and if you wish to view the full text of the legislation please click here. As well, we have attached a summary (similar to what we sent on December 7, 2015 and June 1, 2016) for your easy reference of the 2015 EPC program review that informed the legislation.

Care Watch will review the Bill and share its analysis in the near future. Please feel free to offer your analysis or commentary by writing to us at info@carewatchontario.com.

Michèle HardingDirector, Care Watch

HEALTH ISSUES FOR OLDER WOMEN (and everyone else)

Is our public health care sustainable, now that people are living so much longer?

The belief that our health care is costing too much and will be facing increasing costs as our population ages really is a myth. The ones repeating this myth ad nauseam are those in the medical establishment that wish to water down public, universal health care by bringing in private medical care. Why, they ask, should people who can afford to pay for care and get it NOW not be allowed to do so? Let poor people wait and those with money go to the front of the line (while private doctors charge what the market will bear).

In the first place, it is simply not true that as people get older they must necessarily be a drain on the public health care system. The very fact that the fastest-growing segment of our population are those 85+ years old shows that people are not sicker because they are older, but are living longer because they are not sick. The advances in medical technology and medicines that are keeping the 85+ healthier are already available to the generations coming behind at an earlier age, so it is reasonable to expect that they may live even longer than their parents’ generation.

The most wasteful part of our public system is its minimal investment in health promotion and disease prevention — another case of not looking forward with clear vision.

The strains in our health care financing show themselves first in hospitals — there are too many people in Alternate Level of Care (ALC) beds who are not acutely ill any more but still not well enough to go home or into a long-term care home. This means thats people who need admission to the hospital for an acute condition must wait too long. However, the simplest cure for this problem is being ignored.

Home care is much less expensive than hospital care, and if it was adequately supported, around 38% of those in ALC beds could go home. Additionally, if sub-acute care departments were opened in hospitals (as the Health Services Restructuring Commission recommended over a decade ago), patients who need more help than could be practically offered at home could be cared for economically by nurses with less than registered status, supervised by a registered nurse or a nurse practitioner. This system has worked well in the U.S. and many other countries.

In fact, the intelligent response to the aging of our population is to recognize that acute care hospitals should no longer be the center of our health system. In future, there will be less acute illness and many more persons with chronic conditions who can best be cared for in the community with enhanced primary care and enhanced home care. AGING AT HOME is beginning to be recognized as the virtually universal desire of our older adults. For this dream to be realized requires a number of programs, services and policy decisions:

• Supportive services

• Home care

• Adult day programs

• Integrated community care

• Foster care for seniors

• Sub-acute hospital beds

While post-acute home care can go a long way to reduce the bottlenecks in our hospitals, it is supportive care that can make it possible for seniors with age-related functional disabilities to remain at home. One doesn’t have to be sick to be in danger of having to go into an institution. If you can’t take a bath without help, if you can’t shop for groceries without help, if you need help in preparing meals or keeping a reasonably clean and orderly household — any of these disabilities can force you into an institution when you would much prefer to stay in your own home. This kind of help is called supportive. It is not medical, though it may include reminding seniors when to take their medicines. It is not therapeutic — physiotherapy and other kinds of therapy must be arranged through the Community Access Centers.

Supports which allow older persons to remain in their own homes and communities may be the most precious help that can be offered to them.

by Ethel Meade, December 2010

MORE ABOUT HOME CARE

Though it is not said out loud very often, 85-90% of care for Canada’s elderly is provided by informal (unpaid) caregivers — family, friends or neighbours. Without them, our cherished public health care system would collapse. Despite the heavy load they carry, family caregivers are given neither respect, recognition nor any other kind of support. That is why the big majority of residents in our Long Term Care Homes are women who have seen their husbands through, at a heavy cost to their own health.

Widows outnumber widowers five to one, not just because women tend to marry men older than themselves. Our society still sees caregiving (for the young and the old) as “women’s work.” Still, with elderly spouses, husbands do often step up to the plate and care for their wives, especially if their wives have Alzheimer’s disease.

A number of governmental measures, at both provincial and federal level, could go a long way toward alleviating these problems. For example, a young employed parent (father or mother) is eligible for Employment Insurance for one year to care for a new infant, and equally important, the parent’s job (or an equivalent one) will be held open. The federal government could extend this kind of leave to an employee who must take time off to care for an elderly parent. At present, this leave may be applied for only if a doctor testifies that the elderly person is expected to die within six months.

The second option that could be implemented by the federal government is pension years credit. If you stay at home to care for a child under seven years of age, the years you are out of the labour force are counted as pensionable years when you retire. But if you stay out of the labour force to care for an elderly family member, those years are not counted.

What could a province do to help and support family caregivers? A project undertaken by Care Watch Toronto found that the first item on caregivers’ wish lists was respite: if you are on duty 24 hours a day, seven days a week, you need a break — to go out for dinner, to a movie, to visit a friend. The only break now available in Ontario is a few hours a week of what is called home-making — i.e. vacuuming, scrubbing floors, etc. But if you are caring for an elderly patient with Alzheimer’s or any other form of dementia, or a younger family member with an acquired brain injury, you can’t use these housekeeping hours — unless the person sent to do housekeeping has been specially trained in caring for such “difficult” care recipients. The main problem here is that few persons want this training, since they would then be sure to get all the most difficult assignments and be paid not one cent more than someone who did only routine duties.

For years, OWN and other seniors’ community organizations have lobbied for health care workers to be paid according to their qualifications rather than their place of employment. A health care worker (including nurses) is paid the highest if she gets a job in a hospital, less if she gets a job in a Long Term Care Home, and still less if she works for a Community Care Access Centre. You are paid based not on your qualifications, but on the government’s idea of which situation is the most important.

Finally, there is a way to offer support to family caregivers — by volunteers. A volunteer could give a few hours respite, once a week, once a month or whatever. Another kind of support by vounteers is by elder-sitting while the caregiver meets with a few others who are in the same situation. This kind of project can be initiated and maintained by social workers and social work agencies.

We have a long way to go to achieve a society where family caregivers are recognized for the important work they do, and where more options for helping them are made available. But these are some of the changes that we can keep pushing for.